Adult congenital heart · UK
Closing a hole in the heart, by a specialist congenital-heart team.
ASD, VSD, PFO and PDA closure — through a vein in the groin where it can be, through the sternum where it must be. Guided by one of the 10 NHS-commissioned adult GUCH centres, or a paediatric cardiac centre for children.
Why patients choose us
- 01
A specialist adult congenital cardiologist
A hole in the heart in an adult belongs in a GUCH centre, not a general cardiology clinic. We route you straight to one.
- 02
Percutaneous first, surgery when needed
Most ASDs, PFOs and PDAs close via a vein in the groin — no chest opening. Where a patch and bypass are needed, we say so plainly.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pathway
How closing a hole in the heart is funded in the UK.
Complex adult congenital heart disease is NHS-commissioned centrally. Private review sits alongside the NHS pathway rather than replacing it — we help you use both.
In short
Most ASDs, PFOs and PDAs close via a device in the groin — home the next day, back to full exercise at 4–6 weeks.
| Procedure | Funding | Typical duration | Hospital stay |
|---|---|---|---|
| ASD device closure (percutaneous) | NHS specialist commissioning | 60–120 min | 1 night in hospital |
| PFO device closure (percutaneous) | NHS specialist commissioning | 60–90 min | Day-case / 1 night |
| VSD device closure (muscular) | NHS specialist commissioning | 90–150 min | 1–2 nights |
| PDA device closure (coil or occluder) | NHS specialist commissioning | 45–90 min | Day-case / 1 night |
| Surgical patch closure (ASD or VSD) | NHS specialist commissioning | 3–4 hours | 3–7 nights |
| Private cardiology second opinion | £300–£600 | 45 min | Same visit |
Complex closure is not routinely offered privately in the UK — the specialist expertise sits in a small number of NHS-commissioned centres. What we arrange privately is the second opinion, imaging review and the introduction to the right team.
The problem
The right centre, the right imaging, the right closure.
Congenital heart defects belong in specialist hands. A general cardiology clinic can miss the subtypes — primum vs secundum ASD, perimembranous vs muscular VSD — that decide whether a device or a patch is the right answer.
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Told you have a shunt?
A hole between chambers is a shunt. Which chambers and how big matters — the plan changes with each one.
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A stroke and a PFO?
Under 60 with a cryptogenic stroke and a high-risk PFO — NICE IPG712 supports closure. We route you accordingly.
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Told you need surgery?
Some defects need a patch and cardiopulmonary bypass. Many do not. A second opinion from a GUCH centre confirms which.
The journey
From enquiry to recovery — what happens, in order.
One clinician team from first message to follow-up echo — including cardiac rehab.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A day or a few days in hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, any previous scans or echocardiograms, whether a stroke or shunt has been mentioned.
- 02
Before
We come back with a recommendation
Within one working day: the right GUCH centre, the right imaging, and what NHS specialist commissioning covers versus private review.
- 03
Before
We arrange the assessment
TTE, then TOE or cardiac MRI as needed. A right-heart catheter if pulmonary pressures are in question. Cardiologist and surgeon MDT input.
- 04
On the day
Arrival at the centre
Admission, consent and a chat with the interventional cardiologist or cardiac surgeon and the anaesthetist. Local, sedation or GA — whichever the case needs.
- 05
On the day
The procedure itself
Percutaneous closure: 60–120 minutes via the femoral vein under TOE guidance. Surgical closure: median sternotomy with a pericardial patch on cardiopulmonary bypass.
- 06
On the day
Recovery on the ward
Percutaneous: 24–48 hours in hospital, home the next day. Surgical: 3–7 days in hospital including a short stay on cardiac HDU.
- 07
After
Follow-up and cardiac rehab
Echocardiogram at 6 weeks, 6 months and 12 months. Cardiac rehab after surgical closure. Aspirin for 6 months after a device.
Typical end-to-end: 4–8 weeks from referral to procedure at a GUCH centre. Full healing: 6–8 weeks.
When it helps
When closing a hole in the heart is the right step.
The four defects we see most, the stroke pathway, and the one red flag that changes the plan entirely.
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Atrial septal defect (ASD)
A hole between the two upper chambers. Breathlessness, palpitations and right-heart strain in adulthood — usually closed with a device.
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Ventricular septal defect (VSD)
A hole between the two lower chambers. Small ones may be watched; larger or symptomatic ones need patch closure by a cardiac surgeon.
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Patent foramen ovale (PFO)
A flap-like opening most people are born with. Closed after a cryptogenic stroke in under-60s with a high-risk PFO per NICE IPG712.
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Patent ductus arteriosus (PDA)
A fetal vessel that failed to close. Usually treated in childhood with a coil or device; ligation in adults is rare.
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Cryptogenic stroke under 60
A stroke with no clear cause and a high-risk PFO — CLOSE, REDUCE and RESPECT trials support closure over medication alone.
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Right-heart enlargement on echo
A dilated right ventricle or right atrium on echo is often the first sign an ASD is loading the right side of the heart.
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Paradoxical embolism or platypnoea
Clots crossing a PFO to the brain, or unusual breathlessness on sitting up, can be reasons to close the shunt.
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Red flag: pulmonary hypertension
A very high pulmonary vascular resistance changes the plan entirely — right-heart catheterisation decides whether closure is safe at all.
Procedure options
Device or patch — the right closure for the defect.
What each option on the table actually involves — and which fits which defect.
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ASD percutaneous device closure
Amplatzer, GORE Cardioform or Occlutech device passed via the femoral vein under TOE guidance. Suits secundum ASDs with adequate rims.
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ASD surgical patch closure
Pericardial patch through a median sternotomy on cardiopulmonary bypass. Needed for primum, sinus venosus and large secundum defects without rims.
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VSD surgical patch closure
The standard for symptomatic perimembranous, outlet and inlet VSDs. Approached through the right atrium and aortic root on bypass.
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VSD percutaneous device closure
Reserved for selected muscular VSDs with an Amplatzer device — perimembranous VSDs are approached cautiously because of AV block risk.
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PFO percutaneous device closure
Amplatzer or GORE Cardioform via the femoral vein. Day-case for cryptogenic stroke under 60 with a high-risk PFO (RoPE ≥7, aneurysm, large shunt).
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PDA coil or device closure
Percutaneous coil or occluder in infants and children; surgical ligation only if a percutaneous approach is not feasible.
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Assessment and imaging pathway
Transthoracic echo, TOE for planning, cardiac MRI, and right-heart catheterisation for pulmonary vascular resistance where indicated.
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Cardiology second opinion
An honest review of whether closure is needed, which route fits, and which GUCH centre suits you best — no obligation.
The UK GUCH network
Ten specialist centres, we know them all.
Royal Brompton, Barts, Papworth, the Freeman in Newcastle, Southampton, Bristol, Manchester, Leeds, Belfast and Cardiff. We help you reach the right one for your case.
Selection criteria
How we choose the right centre for you.
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One of the 10 NHS England-commissioned adult GUCH centres for adults
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Paediatric cardiac surgical centre for children and adolescents
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Interventional cardiologist and cardiac surgeon MDT for every case
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TOE, cardiac MRI and right-heart catheterisation available in-house
Safety and recovery
What to expect afterwards — honestly.
Percutaneous device closure is a well-established, safe procedure with a short recovery. Surgical patch closure is bigger, but still routine in a GUCH centre. The specifics differ by defect and device.
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Percutaneous first where possible
Most ASDs, PFOs and PDAs close through a vein in the groin — no chest opening, home the next day.
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Device embolisation is rare
Under 1% with modern devices, and almost always retrievable in the same session by the interventional team.
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Transient atrial fibrillation is common
AF or flutter in the first weeks after ASD closure affects 10–15% of adults — usually settles on its own or with a short course of medication.
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Aspirin for six months
Standard after a device closure — sometimes aspirin plus clopidogrel for the first months. Warfarin or a DOAC instead if you already have AF.
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Endocarditis prophylaxis awareness
For the first six months after a device, antibiotic cover for high-risk dental or surgical procedures is discussed with your dentist.
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AV block risk with perimembranous VSD
The reason percutaneous VSD closure is used cautiously — a heart-block risk that is why surgical patch closure is often preferred.
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Late device erosion is very rare
Under 0.3% for ASD devices — a specific reason follow-up echocardiograms are done at 6 weeks, 6 months and 12 months.
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Migraine can change either way
Some people with migraine with aura improve after PFO closure; a smaller number find migraines worsen. Worth knowing beforehand.
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Red flags
Chest pain, a new fever, severe breathlessness, or a stroke-like episode after closure are not normal — call the centre or 999 the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the cardiologist or surgeon sends you keeps to the same shape.
A quiet reminder
Cardiology language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Defect, size and closure method
Which defect was closed (ASD, VSD, PFO or PDA), its measured size, and whether closure was by device or surgical patch.
- 02 Technique
Access, imaging and device
Femoral vein access and TOE guidance for a device; sternotomy and cardiopulmonary bypass times for a surgical patch. Device brand and size, or patch material.
- 03 Findings
Residual shunt, rhythm and pressures
Notes on any small residual shunt, rhythm on leaving theatre, and pulmonary pressures where measured.
- 04 Impression
Antiplatelets, echo schedule, rehab
Read this first: aspirin duration, endocarditis-prophylaxis window, echocardiogram timing and cardiac-rehab plan.
Recognised by major UK insurers
Adult congenital heart disease is NHS-commissioned in the UK. Private insurance typically covers the second-opinion review and imaging rather than the closure itself — we confirm before booking.
Frequently asked
Everything we get asked about closing a hole in the heart.
Quick answers on ASD vs VSD vs PFO vs PDA, recovery time, and what the NHS pathway looks like.
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What is a hole in the heart, in adult terms?
A shorthand for four different defects — atrial septal defect (ASD), ventricular septal defect (VSD), patent foramen ovale (PFO) and patent ductus arteriosus (PDA). They differ in where the hole sits and how they are closed, and the treatment plan depends on which one you have.
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Is closing a hole in the heart done on the NHS or privately?
In the UK, adult congenital heart disease is commissioned centrally by NHS England through 10 specialist GUCH centres, and children are treated in paediatric cardiac centres. Private complex closure is not routine in the UK — a private second opinion often runs alongside the NHS pathway.
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Which GUCH centres handle this in adults?
The 10 commissioned adult GUCH centres are Royal Brompton, Barts, Papworth, the Freeman in Newcastle, University Hospital Southampton, Bristol Royal Infirmary, Manchester, Leeds, Belfast and Cardiff. We help you reach the right one for your case.
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Do I need a chest operation, or can it be done through a vein?
Most ASDs, PFOs and PDAs are closed percutaneously through the femoral vein — no chest opening, one night in hospital. VSDs and ASDs that lack adequate rims usually need surgical patch closure through a median sternotomy on cardiopulmonary bypass.
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When should a PFO be closed after a stroke?
NICE IPG712 supports closure in patients under 60 who have had a cryptogenic stroke and a high-risk PFO — a RoPE score of 7 or more, an atrial septal aneurysm, or a large right-to-left shunt. This follows the CLOSE, REDUCE and RESPECT trials.
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How long does recovery take?
After a percutaneous device: home the next day, back to office work in a week, full exercise at four to six weeks. After a surgical patch: 3–7 days in hospital, six weeks off driving, and cardiac rehabilitation over the following weeks.
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What are the risks of device closure?
Device embolisation is under 1% and almost always retrievable. Transient atrial fibrillation affects 10–15% of ASD patients in the first weeks. Late device erosion is under 0.3%. A perimembranous VSD carries a small AV-block risk, which is why that closure is done cautiously.
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Will migraine change after PFO closure?
It can — either way. Some people with migraine with aura report improvement after PFO closure; a smaller number find migraines worsen. It is worth discussing before deciding on the procedure if migraine is part of your picture.
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